How is anaemia commonly diagnosed?

Question

I am reading from the Australian Medical Council, Anthology of Medical Conditions (2003). Under the key objectives for presenting anaemia and pallor it says:

"By considering the clinical context, determine if anaemia is present, since all three laboratory indices of anaemia are concentration measurements." (p.91)

I am not a clinician, so to me this wording seems vague. In the first half it seems that clinicians may determine the presence of anaemia based on signs and symptoms elicited in the initial consultation, but in the second half it seems that clinical context includes the interpretation of bloodwork.

Can anyone clarify what is meant? Or instead tell me how one approaches anaemia?

Professional guidelines or medical references preferred above journal articles.

Answer 1

In the context of your question, the clinical context is limited to a patient's history (symptoms and relevant circumstances) and signs discovered during a physical examination, which can include manual tests and tests using a stethoscope and other simple instruments. Clinical context here does not include laboratory tests and other tests that involve "machines" (ultrasound, CT, EKG, etc.).

It may help if you imagine that the term clinical originates from the Greek kline, which means bed, so clinical refers to what a doctor can do "beside bed."

(Outside of the context of your question, the term clinical can be used very broadly, for example, for everything what includes hospitals (clinics) and for pretty much all interactions between doctors and patients.)

The process of diagnosing anemia includes the evaluation of:

1) Circumstances, for example, a vegan who does not eat a lot (and hence probably consumes only little iron), or a history of anemia in family members (genetic types of anemia).

2) Symptoms, such as tiredness

3) Signs, revealed during a physical examination, such as pallor and fast heart rate

4) Blood tests: low hemoglobin and ferritin, small erythrocite volume, etc.

Sources:

• Iron Deficiency Anemia: Evaluation and Management (American Family Physician, 2013)
• Diagnostic approach to Anemia (University of Utah School of Medicine, 2014)